<div class="layuimini-container">
    <form id="app-form" class="layui-form layuimini-form">
        
        <div class="layui-form-item">
            <label class="layui-form-label">订单id</label>
            <div class="layui-input-block">
                <input type="text" name="order_id" class="layui-input"  placeholder="请输入订单id" value="{$row.order_id|default=''}">
            </div>
        </div>
        <div class="layui-form-item">
            <label class="layui-form-label">原价</label>
            <div class="layui-input-block">
                <input type="text" name="original_price" class="layui-input"  placeholder="请输入原价" value="{$row.original_price|default=''}">
            </div>
        </div>
        <div class="layui-form-item">
            <label class="layui-form-label">优惠金额</label>
            <div class="layui-input-block">
                <input type="text" name="coupon_price" class="layui-input"  placeholder="请输入优惠金额" value="{$row.coupon_price|default=''}">
            </div>
        </div>
        <div class="layui-form-item">
            <label class="layui-form-label">结算金额</label>
            <div class="layui-input-block">
                <input type="text" name="settlement_amount" class="layui-input"  placeholder="请输入结算金额" value="{$row.settlement_amount|default=''}">
            </div>
        </div>
        <div class="hr-line"></div>
        <div class="layui-form-item text-center">
            <button type="submit" class="layui-btn layui-btn-normal layui-btn-sm" lay-submit>确认</button>
            <button type="reset" class="layui-btn layui-btn-primary layui-btn-sm">重置</button>
        </div>

    </form>
</div>